The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

Abstract

Research objective The COVID-19 pandemic disrupted healthcare delivery worldwide with likely negative effects on people who use opioids (PWUO). This scoping review of the original research literature describes the impact of the COVID-19 pandemic on healthcare delivery for PWUO and identifies gaps in the literature. Methods This scoping review of the original research literature maps the available knowledge regarding the impact of the COVID-19 pandemic on healthcare delivery for PWUO. We utilized the methodology developed by the Joanna Briggs Institute for scoping reviews, and content analyses methodology to characterize the current state of the literature. Results Of the 14 included studies, administrative database (n = 11), cross-sectional (n = 1) or qualitative (n = 2) studies demonstrated service gaps (n = 7), patient/provider experiences (n = 3), and patient outcomes for PWUO (n = 4). In March 2020, healthcare utilization dropped quickly, sharply increasing only for reasons of opioid overdose by May 2020. Service gaps existed in accessing treatment for new patients during the pandemic due to capacity and infrastructure limits. Physicians reported difficulty referring patients to begin an outpatient opioid treatment program due to increased restrictions in capacity and infrastructure. Patients also reported uncertainty about accessing outpatient treatment, but that telehealth initiation of buprenorphine increased access to treatment from home. Disproportionate increases in overdose rates among African Americans were reported in two studies, with differences by race and gender not examined in most studies. Fatal overdoses increased 60% in African Americans during the pandemic, while fatal overdoses in Non-Hispanic White individuals decreased. Conclusions In summary, this beginning evidence demonstrates that despite early reluctance to use the healthcare system, opioid overdose-related use of healthcare increased throughout the pandemic. Service delivery for medications to treat OUD remained at or above pre-pandemic levels, indicating the ability of telehealth to meet demand. Yet, racial disparities that existed pre-pandemic for PWUO are intensifying, and targeted intervention for high-risk groups is warranted to prevent further mortality. As the pandemic progresses, future research must focus on identifying and supporting subgroups of PWUO who are at heightened risk for experiencing negative outcomes and lack of access to care.

Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times

“…Our study provides a characterization of evidence regarding the impacts of the COVID-19 pandemic on a comprehensive range of outcomes concerning illicit substance use within US-specific contexts over the first two waves. Other scoping reviews that shared similar goals have either presented generalized global findings [ 16 ] or were narrowed in scope to specific outcomes or study populations (i.e., opioid use-related disorders only) [ 14 , 15 , 17 ]. Our findings address more discrete research questions to rigorously characterize and complement the evidence (through full data extraction provided in Appendix A–C) and guide subsequent research.…”

“…Whereas previous review articles have examined various interactions between the COVID-19 pandemic and substance use in the US [ 14 , 15 , 16 , 17 ], none have sought to systematically synthesize and appraise the quantitative evidence that emerged during the midst of this crisis on the impact of key changes in individual and structural level determinants of substance use risk and their associated health outcomes. A rigorous approach is therefore needed to describe it and support the formulation of unbiased inferences, particularly with regards to the priorities for future research and the implications for policymakers in responding to similar crises in the future within US communities.…”

Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums

“…Studies have shown that people may seek forums and self-help groups to provide emotional support [ 39 - 42 ], particularly given online forums may allow anonymous disclosure without feelings of shame or guilt [ 43 ]. Finding emotional support without being stigmatized is especially relevant for PWUD [ 44 ] and is an urgent matter, given opioid overdose–related use of health care has increased throughout the pandemic. Future research should examine subgroups of PWUO who may be at heightened risk for reduced access to care during the pandemic [ 44 ].…”

“…Finding emotional support without being stigmatized is especially relevant for PWUD [ 44 ] and is an urgent matter, given opioid overdose–related use of health care has increased throughout the pandemic. Future research should examine subgroups of PWUO who may be at heightened risk for reduced access to care during the pandemic [ 44 ].…”

Changes in Racial/Ethnic Disparities in Opioid-Related Outcomes in Urban Areas during the COVID-19 Pandemic: A Rapid Review of the Literature

“…Telemedicine has been increasingly described as a solution for improving access to OUD treatment, and there is a growing body of research on the use of telemedicine during the pandemic and beyond [ 35 ]. Treatment initiation via telemedicine was found to increase access to treatment from home using buprenorphine [ 36 ]. However, more research is needed to understand whether there is variation in the use of telemedicine across race/ethnicity groups that could result in disparities.…”